Leesburg, VA, October 11, 2022—According to an article in ARRS’ American Journal of Roentgenology (AJR), findings on gadoxetate disodium-enhanced MRI, including hepatobiliary-phase characteristics, were associated with hepatocellular adenomas (HCA) subtypes using the 2017 genotypic classification.
“The proposed diagnostic algorithm identified common HCA subtypes with high accuracy, including those with β-catenin exon 3 mutations,” wrote first author Justin R. Tse, MD, of Stanford University School of Medicine. “HCAs without features of hepatocyte nuclear factor-1β mutated HCA (H-HCA) or inflammatory HCA (I-HCA)—but with hepatobiliary-phase iso- or hyperintensity—are suspicious for β-catenin exon 3 HCA (β-HCA) or mixed inflammatory and β-catenin exon 3 HCA (βI-HCA), which have increased malignant transformation risk.”
Dr. Tse and team’s retrospective study included 56 patients (49 women, 7 men; mean age, 37 years) with histologically confirmed HCA evaluated by gadoxetate disodium-enhanced MRI from January 2010 to January 2021. Using 2017 criteria, subtypes were reclassified: H-HCA, I-HCA, β-HCA, βI-HCA, as well as sonic hedgehog HCA (SH-HCA), a newly recognized subtype with the highest risk of symptomatic bleeding. After assessing qualitative MRI features, measuring liver-to-lesion contrast enhancement ratios, and comparing subtypes, the investigators generated a stepwise diagnostic algorithm for determining HCA subtype, based on findings from their present analysis and relevant earlier studies.
Ultimately, H-HCAs showed homogeneous/diffuse intralesional steatosis in 94% of the cohort. I-HCAs showed atoll sign in 58% and moderate T2-hyperintensity in 58%. Meanwhile, β-HCAs and βI-HCAs occurred in men in 63%, had mean size of 10.1 cm, and showed fluid components in 60% and hepatobiliary-phase iso- or hyperintensity in 80%. The SH-HCA subtype lacked distinguishing characteristics.
An electronic supplement to this AJR article is available here.
North America’s first radiological society, the American Roentgen Ray Society (ARRS) remains dedicated to the advancement of medicine through the profession of medical imaging and its allied sciences. An international forum for progress in radiology since the discovery of the x-ray, ARRS maintains its mission of improving health through a community committed to advancing knowledge and skills with the world’s longest continuously published radiology journal—American Journal of Roentgenology—the ARRS Annual Meeting, InPractice magazine, topical symposia, myriad multimedia educational materials, as well as awarding scholarships via The Roentgen Fund®.
Logan K. Young, PIO
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American Journal of Roentgenology
Method of Research
Subject of Research
Hepatocellular Adenoma Subtypes Based on 2017 Classification System: Exploratory Study of Gadoxetate Disodium–Enhanced MRI Features With Proposal of a Diagnostic Algorithm
Article Publication Date
Disclosures: Justin Tse has a pending grant from Bayer.